Oxfordshire Girls Rugby

PLEASE COMPLETE AND BRING TO COUNTY TRIALS ON 28TH SEPTEMBER

Registration 2017/2018

Name

School year

Club

School

Preferred position 1

Preferred position 2

Primary contact name#

Primary contact email

Primary contact mobile

Player email# a parent or guardian is required as primary contact

Availability

Please indicate below your availability for the scheduled County training sessions and fixtures. For away fixtures please indicate whether or not you will be able to arrange your own travel to the host location as centrally provided transport, for example by coach, is not guaranteed.

Date / location Available (Y/N) Travel (please delete as appropriate)

Thurs 26th OctTraining – Gosford AB

Y / N I Will be able to get to the venue /

I require transportSun 29th Oct

Fixture – Banbury, Oxfordshire

Y / NI Will be able to get to the venue /

I require transport

Thurs 16th NovTraining – Gosford AB

Y / NI Will be able to get to the venue /

I require transportSun 19th Nov

Fixture – Camborne, Cornwall

Y / NI Will be able to get to the venue /

I require transport

Thurs 30th NovTraining – Gosford AB

Y / NI Will be able to get to the venue /

I require transportSun 3rd Dec

Fixture – Drybrook, Gloucestershire

Y / NI Will be able to get to the venue /

I require transport

Registration page 1 of 1

Oxfordshire Girls Rugby

PLEASE COMPLETE AND BRING TO COUNTY TRIALS ON 28TH SEPTEMBER

Emergency Contacts, Medical Information and Consents 2017/2018

I understand that my daughter / ward has been selected for the 2017/2018 Oxfordshire RFU Development Squad. I hereby give permission for my daughter / ward to take part in the associated training / matches organised by Oxfordshire RFU for the 2017/18 season.

Player’s Full Name

Date of Birth

Home Address and Postcode

In the case of any injury arising during these activities I consent to my daughter / ward receiving medical treatment which in the opinion of a qualified medical practitioner may be necessary. I understand that in the event of an emergency every effort will be made to contact the following:

Primary Emergency Contact Details

Name

Relationship to player

Home telephone

Mobile telephone

email

Alternative Emergency Contact Details

Name

Relationship to player

Home telephone

Mobile telephone

email

Emergency Contacts, Medical Information and Consents page 1 of 4

Oxfordshire Girls Rugby

Medical Information

Does your daughter / ward currently suffer or has she suffered from any of the following:

Asthma Y / N

Diabetes Y / N

Epilepsy Y / N

Allergies Y / NIf yes please give details

Other medical conditions Y / NIf yes please give details (use an additional sheet if necessary)

Current Medication Please give details

Recent Injuries Please give details (use an additional sheet if necessary)

Previous Concussion/s Y/NDate (s):

Specific Dietary Requirements

Any other relevant information

GP name and address

Emergency Contacts, Medical Information and Consents page 2 of 4

Oxfordshire Girls Rugby

I confirm to the best of my knowledge that my daughter / ward does not suffer from any medical conditions other than those detailed.

I confirm that I will inform the RFU of any changes to my daughter’s / ward’s medical details.

Photographs and Recorded Images

I consent / do not consent (delete as applicable) to the photographing / videoing and publication of images of my above named daughter / ward under the RFU’s child protection and best practice guidelines, and I confirm that I am legally entitled to give this consent. I also confirm that my above named daughter / ward is not under a court order at present.

Parent/ Guardian Name

Parent/ Guardian Signature Date

I also consent to the photographing / videoing and publication of images of my involvement in rugby union under the RFU’s Child Protection and Best Practice guidelines.

I have read and abide by the Code of Rugby (see overleaf)

Player Name

Player Signature Date

Emergency Contacts, Medical Information and Consents page 3 of 4

Oxfordshire Girls Rugby

Emergency Contacts, Medical Information and Consents page 4 of 4